Self-Monitoring Kidney Function Post Transplantation: Reliability of Patient-Reported Data.

Céline Van Lint,Ton Jm Rövekamp,Sandra Van Dijk,Mark A Neerincx,Ton J Rabelink,Willem-Paul Brinkman,Wenxin Wang,Paul Jm Van Der Boog

doi:10.2196/jmir.7542

Abstract

BackgroundThe high frequency of outpatient visits after kidney transplantation is burdensome to both the recovering patient and health care capacity. Self-monitoring kidney function offers a promising strategy to reduce the number of these outpatient visits.ObjectiveThe objective of this study was to investigate whether it is safe to rely on patients’ self-measurements of creatinine and blood pressure, using data from a self-management randomized controlled trial.MethodsFor self-monitoring creatinine, each participant received a StatSensor Xpress-i Creatinine Meter and related test material. For self-monitoring blood pressure, each participant received a Microlife WatchBP Home, an oscillometric device for blood pressure self-measurement on the upper arm. Both devices had a memory function and the option to download stored values to a computer. During the first year post transplantation, 54 patients registered their self-measured creatinine values in a Web-based Self-Management Support System (SMSS) which provided automatic feedback on the registered values (eg, seek contact with hospital). Values registered in the SMSS were compared with those logged automatically in the creatinine device to study reliability of registered data. Adherence to measurement frequency was determined by comparing the number of requested with the number of performed measurements. To study adherence to provided feedback, SMSS-logged feedback and information from the electronic hospital files were analyzed.ResultsLevel of adherence was highest during months 2-4 post transplantation with over 90% (42/47) of patients performing at least 75% of the requested measurements. Overall, 87.00% (3448/3963) of all registered creatinine values were entered correctly, although values were often registered several days later. If (the number of) measured and registered values deviated, the mean of registered creatinine values was significantly lower than what was measured, suggesting active selection of lower creatinine values. Adherence to SMSS feedback ranged from 53% (14/24) to 85% (33/39), depending on the specific feedback.ConclusionsPatients’ tendency to postpone registration and to select lower creatinine values for registration and the suboptimal adherence to the feedback provided by the SMSS might challenge safety. This should be well considered when designing self-monitoring care systems, for example by ensuring that self-measured data are transferred automatically to an SMSS.

Highlights

MethodsAfter kidney transplantation, an early detection of transplant failure is mandatory to minimize permanent damage to the transplanted organ
Patients’ tendency to postpone registration and to select lower creatinine values for registration and the suboptimal adherence to the feedback provided by the Self-Management Support System (SMSS) might challenge safety
Before starting to self-monitor kidney function at home, 4 patients canceled their participation because they reported having little trust in the creatinine device, experienced difficulties when logging into the SMSS, experienced business rush, or had a worsened condition post transplantation

Summary

Introduction

MethodsAfter kidney transplantation, an early detection of transplant failure is mandatory to minimize permanent damage to the transplanted organ. Blood level of creatinine is considered the most important indicator of kidney function [1] Patients have their serum creatinine checked on average 20 times during the first year post transplantation. As hypertension is both a potential indicator of decreased kidney function and an important risk factor for kidney graft failure [2,3,4,5], blood pressure needs extensive monitoring too. Self-monitoring could improve the speed of rejection detection as measurements can take place more frequently while at the same time the high number of outpatient visits could be reduced and replaced by telephonic consults. Self-monitoring kidney function offers a promising strategy to reduce the number of these outpatient visits

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Conclusion